NPIMap

Organization Active NPI

Fayetteville State University

  • Clinic Pharmacy
  • Fayetteville, NC
National Provider Identifier
1528547718
Registry record updated Nov 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
04032 Issued in NC
Legal business name
FAYETTEVILLE STATE UNIVERSITY
Practice address
1200 Murchison Road
Student Health Services
Fayetteville, NC 28301-4252
Phone
(910) 672-2602
Fax
(910) 500-6680
NPI assigned
Aug 9, 2018
Last updated
Nov 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ieschecia Nytonya Graham Allen, MS, RHIT
Title
Executive Director
Phone
(910) 672-2602

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 04032 NC Primary

Addresses

Primary practice location

1200 Murchison Road
Student Health Services
Fayetteville, NC 28301-4252

Mailing address

1200 Murchison Road
Student Health Services
Fayetteville, NC 28301-4252
Phone (910) 672-2602

Other names 1

  • Student Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Fayetteville State University2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700784000000",
    "number": "1528547718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MURCHISON ROAD",
            "address_2": "STUDENT HEALTH SERVICES",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014252",
            "telephone_number": "910-672-2602",
            "fax_number": "910-500-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MURCHISON ROAD",
            "address_2": "STUDENT HEALTH SERVICES",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014252",
            "telephone_number": "910-672-2602",
            "fax_number": "910-500-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2023-11-24",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "GRAHAM ALLEN",
        "authorized_official_first_name": "IESCHECIA",
        "authorized_official_middle_name": "NYTONYA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-672-2602",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, RHIT"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NC",
            "license": "04032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Student Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.